Issues in school-based child sexual abuse prevention

SUMMARY. Despite their recognition of the need for teacher training to enable them to respond effectively to the problems of child sexual abuse (DES Circular 4/88) measures taken by the Government to provide that training appear, so far, to be inadequate. Further cause for concern lies in the introduction into schools of child sexual abuse prevention programmes, many of which are seriously flawed, have not been scientifically evaluated and contain unintended negative consequences for both children and teachers. Here, a number of these shortcomings are examined, recent research is reviewed and a wider, more unified and coordinated approach is suggested.     

Experimental avoidance and high-risk sexual behavior in survivors of child sexual abuse

While many long-term correlates of child sexual abuse (CSA) have been identified, theories to explain the development of these correlates have received little empirical validation. The process of experiential avoidance is one theory that has been proposed to account for many of the correlates of CSA. The purpose of the current study was twofold: (1) To attempt to develop a more complex measure of experiential avoidance in women with and without a CSA history, and (2) to explore variables related to two of the long-term correlates of CSA, general psychological distress and high risk sexual behavior. Levels of current distress, high-risk sex, and experiential avoidance were examined in 257 undergraduate females (mean age 20.0) using self-report questionnaires. The results of the current study indicate that CSA survivors report higher levels of experiential avoidance and high-risk sexual behavior with persons other than their primary partners. Implications of these findings for theory development, therapy with CSA survivors, and HIV prevention programs are discussed.     

Including siblings in the treatment of child sexual abuse

Siblings are often not included in treatment programs for children who have been sexually abused. This article describes the necessity of including siblings in the treatment of victims of child sexual abuse. Including siblings in treatment permits families to realize the maximum benefits of therapy for the victim as well as each family member. Theoretical and practical reasons to include siblings in treatment are discussed (i.e., preventing future abuse, providing support for siblings, teaching siblings to refrain from victim-blaming). Case examples using a particular intervention approach at The Family Learning Program and results of client satisfaction surveys are described.     

Group issues and activities for female teen survivors of sexual abuse

The impact of sexual abuse can be devastating, especially for young girls at the crucial stage of adolescent development. Ramifications for these survivors of incest and extrafamilial abuse are addressed. Group therapy as an effective means of intervention is described. Group considerations discussed include group name; member and leadership selection; confidentiality; contracting and closed nature; parent meetings; self-disclosure; and objectives.Twelve weeks of group topics, activities, and homework are detailed. These topics are applicable to most female teen survivors of sexual abuse, independent of the age or gender of their perpetrators.     

Increasing the usability of cognitive processing therapy for survivors of child sexual abuse

There is an ongoing need for empirically based treatments for child sexual abuse (CSA) that are time-efficient and cost-effective. This article describes a modification of cognitive processing therapy for child sexual abuse (CPT-SA) that increases the therapy's usability by reducing the number of individual therapy sessions required. The modifications are based on the developing literature on stage-based approaches to the treatment of CSA and incorporate dialectical behavior therapy skills training into the treatment protocol. Initial pilot data (N = 6) on modified CPT-SA suggests the therapy may be effective for the treatment of posttraumatic stress disorder (PTSD) and depression.     

Ethnicity and child sexual abuse experiences of female college students

This research examines the understudied issue of race/ethnicity in relation to child sexual abuse experiences (CSA) in a cross-sectional convenience sample of 461 female college students completing a survey. Comparisons of students' abuse experiences revealed ethnic differences in sexual abuse prevalence, severity of abuse, the victim- offender relationship and post-abuse coping. Black students reported more sexual abuse than other ethnic groups, followed by Hispanics, Whites, and Asians. Although timing and extent of disclosure of sexual abuse did not vary by ethnicity, negative social reactions to disclosure were more common for certain ethnic groups than others. No ethnic differences emerged for depressive or PTSD symptoms. Implications are drawn for future research on the issue of ethnic differences in the aftermath of CSA experiences.     

Countertransference issues in the in-home treatment of child sexual abuse

Strong emotions are aroused in people in the presence of child abuse. For the therapist trying to help abusive families, these feelings can destroy any prospect of achieving a therapeutic process. This problem is particularly acute in the in-home situation.     

Profiles of adult survivors of severe sexual,physical and emotional institutional abuse in Ireland

Adult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for Disorders of the Diagnostic and Statistical Manual of Mental Disorders IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups that described severe sexual (N = 60), physical (N = 102), or emotional (N = 85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterised by higher rates of all forms of child maltreatment and higher rates of post‐traumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services. Copyright © 2009 John Wiley & Sons, Ltd.     

Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors

This research examined victim relationship to the perpetrator, disclosure characteristics, social reactions, and PTSD in adult survivors' of child sexual abuse (CSA) identified in a convenience sample of 733 college students. Results indicated that relationship to the perpetrator was related to CSA characteristics and outcomes. More negative reactions such as disbelief were observed for those victimized by relatives compared with acquaintance and stranger victims, especially for those disclosing in childhood. Victims of relatives had more PTSD symptoms if they delayed disclosure, received more negative reactions in childhood, and engaged in self-blame at the time of the abuse. Results are discussed in the context of Freyd's (1996) betrayal trauma theory, in order to better understand the traumatic impact of CSA.     

Efficacy of a group intervention for adult women survivors of sexual abuse

This study evaluates the effects of a group intervention for women sexually abused in childhood or adulthood. The sample consisted of 41 women involved in a group intervention based on a feminist approach offered by help centers for sexual assault victims in Quebec and 11 women in a wait-list comparison group. Results reveal that the group intervention reduced psychological distress and consequences associated with sexual abuse and that gains were maintained at three-month follow- up. Analyses of potential factors related to differential gains indicated that abuse-related variables and concurrent individual interventions were not linked to outcomes. Exploratory analyses suggested that women experiencing severe physical partner violence showed greater gains with respect to self-blame/stigmatization, sexual anxiety, and anxiety related to assertiveness.     

An integrated treatment approach to child sexual abuse in the family

SUMMARY. In responding to the increasing professional recognition of child sexual abuse within the family, this paper, relating data from a clinical sample to epidemiological studies, is the first of a number devoted to experimental approaches being taken to identify and treat this problem. The author goes on to describe the multi-disciplinary approach taken at the Tavistock Clinic and other treatment centres. The need for close cooperation and coordination of all professionals concerned and for the involvement of all family members in different forms of treatment is particularly emphasised. This paper was given at the 11th International Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions, Paris, July 1986     

The process of coping with domestic violence in adult survivors of childhood sexual abuse

Research suggests that the use of disengaged or avoidant strategies to cope with interpersonal violence contributes to the development of depressive symptoms and other psychological difficulties. Survivors of childhood sexual abuse (CSA) who are exposed to subsequent episodes of abuse may be more likely to rely on disengaged coping strategies, placing them at elevated risk of psychological symptomatology. In this study, we explored the interrelationships between coping, depression, and self-esteem in an ethnically diverse sample of domestic violence survivors (N = 219) with and without a history of CSA. As predicted, CSA survivors (n = 86) reported significantly greater use of disengaged coping strategies (wishful thinking, self-criticism, and social withdrawal) than non-CSA survivors (n = 133). As hypothesized, both a CSA history and the use of disengaged coping significantly predicted higher levels of depression and lower self- esteem. Clinical implications of the findings are discussed.     

Partner awareness regarding the adult sequelae of childhood sexual abuse for primary and secondary survivors

This qualitative study investigates factors that may facilitate or impede awareness within couples regarding the sequelae of childhood sexual abuse for adult females and their partner. Six couples were interviewed about perceived effects of the abuse for self and partner and their perceptions regarding their awareness of these effects. Transcribed data were analyzed using grounded-theory methodology. Emergent themes regarding potential barriers to and facilitators of agreement are outlined in the context of the expressive and receptive abilities and motivations of each partner in communicating about the abuse. Preliminary implications for marriage and family therapy and further research are provided.     

Effects of group therapy on female adolescent survivors of sexual abuse: a pilot study

Treatment interventions for female sexual abuse survivors was explored through a pilot study examining the relationship between group treatment and adolescent self-image. Self-image was defined as body image, self-reliance, self-control, and impulse-control. An experimental pre-post design was utilized. Participants were 13 female adolescent high school drop-outs with a history of sexual abuse who participated in the National Guard Youth Challenge Program at Camp Shelby in Mississippi. Participants completed the Offer Self- Image Questionnaire for Adolescents. The hypothesis that group therapy was an effective intervention for sexual abuse survivors was not supported; however, this is likely due to the small sample size. Because this was a pilot study, mean trends were observed to see directional changes that may assist future researchers. Observation of mean trends revealed that participants who received group therapy increased in levels of impulse control while the group that did not receive group therapy remained the same. Mean trends also revealed that the experimental group had a decrease in self-reliance whereas the control group maintained their levels of self-reliance.     

Relationships between maternal adult attachment security, child perceptions of maternal support, and maternal perceptions of child responses to sexual abuse

This study assessed the relationships between maternal adult attachment style, children's perceptions of maternal support following disclosure of sexual abuse, and maternal perceptions of children's behavioral and emotional responses to sexual abuse among African-American child sexual abuse victims aged 4 to 12 (n=96) and a comparison group of non-abused subjects (n=100). Mothers with insecure attachment styles reported significantly higher rates of internalizing behaviors in their sexually abused children than did securely attached mothers. Among mothers of non-abused children, those with insecure adult attachment styles reported significantly higher rates of externalizing behaviors shown by their children in comparison with mothers with a secure adult attachment style. Mothers with insecure adult attachment styles also reported higher rates of overall behavior problems in their non-abused children that approached statistical significance. Sexually abused children's perceptions of maternal support were not related to maternal attachment style nor to child functioning. Contrary to our prediction, mothers of sexually abused children did not show lower rates of secure attachments when compared to mothers of non-sexually abused children. Our findings indicate that fostering parent- child attachment is important in order to decrease the risk for behavior problems and symptomatology in sexually abused children.     

Cultural issues in disclosures of child sexual abuse

Cultural norms affect the likelihood that child sexual abuse will be discovered by an adult or disclosed by a child. Cultural norms also affect whether abused children's families will report child sexual abuse to authorities. This article explores the ways ethnic and religious culture affect child sexual abuse disclosure and reporting, both in the United States and internationally. Guidelines for culturally sensitive child abuse interviewing are provided to facilitate disclosures of abuse from culturally diverse children in formal settings.     

Transference and countertransference in the treatment of adult survivors of abuse with a somatoform disorder

The understanding of transference and countertransference has changed a great deal since Freud introduced the terms. A case example indicates one way the patient’s and clinician’s past experiences and expectations interact to create a here and now relationship that is highly influenced by transference/countertransference. The understanding of both terms as aspects of a mutually constituted interaction has practice implications for the treatment of adult survivors of abuse who have a somatoform disorder.     

Negative impact of sexual abuse on adult male gender: Issues and strategies of intervention

Although male sexual abuse has co-existed with female sexual abuse, the professional literature has paid minimal attention to the impact of sexual abuse of male children to their adult adaptation. This paper concentrates on the negative impact of sexual abuse on the adult male's gender identity. Examples of eight male clients' responses to sexual abuse in their adult life and the therapeutic framework utilized to work with them are discussed in the paper.This paper was originally presented at the ICAPP conference, 1993.He teaches advanced clinical practice, Human Behavior and AIDS ELECTIVE. He maintains a private practice specializing in Gay men, persons with HIV virus.